Veterinary Neurological Conditions

AMC's neurology team

The Animal Medical Center has 36 board certified specialists in 17 different specialties. Neurology is a critical specialty at AMC and we are lucky to have three experienced specialists in veterinary neurology who are available to AMC patients seven days a week. The Neurology Service also trains the next generation of veterinary neurologists and currently has three residents in training. Many readers might not be familiar with common neurologic disorders of dogs and cats, so I will highlight them in this blog post.

Top Neurologic Conditions
The most common problems managed by AMC’s Neurology Service include seizures in dogs and cats, disc problems in the backs of dogs, and vestibular disease. A seizure occurs because the electrical system of the brain goes haywire. Seizures occur in all breeds of dogs and cats. Intervertebral disc disease has clear breed predictions. If you have a French bulldog, a dachshund, or a cocker spaniel, your dog is at increased risk of developing a slipped disc. All dog owners should be aware of the problem of slipped discs in dogs and seek emergency care if their dog suddenly can’t walk. When the disc slips out of its normal place, the disc pushes on the spinal cord causing pain and affecting the nerves controlling the back legs. Vestibular disease may also result in the sudden inability to walk, but dogs tend not to be painful, just very dizzy and often nauseous.

Intersection of Medicine and Neurology
Certain medical conditions can mimic neurologic ones. For example, a low blood sugar level deprives the brain of necessary fuel and can result in a seizure that is different than a seizure caused by epilepsy or a brain tumor. Fainting might look like a seizure or an episode of vertigo, but in cats, fainting is commonly caused by heart disease. Pet owners might think shaking is a neurologic condition, but the causes of shaking in dogs include hormone disorders, low calcium levels post-partum, and ingestion of toxic substances.

Neurology Diagnostic Tools
AMC has both a CT scanner and an MRI. Neurology typically uses the MRI to diagnose disorders of the brain and spinal cord. Dogs with back problems have an MRI, often in the middle of the night, before surgery to remove an out of place intravertebral disc. An MRI scan is also the test of choice in patients with seizures. Neurologists may also perform a spinal tap in seizure patients to evaluate the fluid around the brain to determine the cause of the seizures.

If you have a pet with a neurologic condition or want to learn more about veterinary neurology, tune in to “Ask the Vet” on SiriusXM Stars channel 109 on Friday, September 7 at 1pm EDT to hear an interview with AMC’s chief neurologist Dr. Chad West.

The Difference Between Diagnostic Radiology, Radiation Therapy and Interventional Radiology

radiation therapy

At first glance, these three disciplines within veterinary medicine seem pretty much the same, but at the Animal Medical Center, diagnostic radiology, radiation therapy, and interventional radiology represent three different groups of veterinarians with three very different sets of background and training. What ties these three disparate groups together is their use of radiation to diagnose and treat disease.

Diagnostic Radiology
These days you are more likely to find a Department of Diagnostic Imaging in a hospital than a Radiology Department. Radiology is an older term, used when x-rays were the only testing modality using radiation available in medicine. Today, AMC’s Diagnostic Imaging Service uses not only traditional x-rays but also ultrasound, computed tomography (CT) scans, and magnetic resonance imaging (MRI) in the diagnostic evaluation of patients. AMC’s Diagnostic Imaging Service also has a fluoroscopy unit, which is like a video x-ray. This machine allows us to watch bodily functions like blood flow or swallowing in real time. To see an example of fluoroscopy, read about Molly the Ganaraskan. Every veterinarian at AMC depends on our diagnostic imaging team for their expertise in imaging sick pets and helping us to make an accurate diagnosis.

Radiation Therapy
A very accurate description, AMC’s Radiation Oncology Service uses radiation to treat tumors. Specifically, we have a linear accelerator (linac), a giant machine that creates various types of radiation depending on patient needs. Our state-of-the-art linac can make electrons for superficial treatments, produce high energy pinpoint beams for stereotactic radiosurgery, and stereotactic body radiation therapy. Diagnostic Imaging’s CT scanner interfaces with Radiation Oncology’s 3-D computer planning system. The interface allows the linac’s multileaf collimator to sculpt the radiation beam to precisely target the tumor being treated. The veterinarians working in radiation therapy have training in both the physics of radiation as well as the management of cancer.

Interventional Radiology
Specialists in interventional radiology use minimally invasive techniques to make image-guided diagnoses and also deploy high tech treatments for a variety of diseases. Using a range of techniques which rely on the use of images generated by diagnostic radiology equipment such as fluoroscopy, ultrasound, CT scan, or MRI imaging, the interventional radiologist precisely targets various organs with treatments such as stents, occluders and medications. Watch a video where AMC’s interventional radiology team uses fluoroscopy to close off abnormal blood vessels in the liver. The veterinarians in our Interventional Radiology Service have diverse backgrounds in surgery, internal medicine plus specialized training to use minimally invasive equipment.

Linked together by their use of radiation as a diagnostic and therapeutic tool, diagnostic radiology, radiation therapy and interventional radiology are just a few of the highly trained specialists at AMC working to make sick pets healthy again.

Clea’s International Healthcare Team: Partnering for Cancer Care

Last spring, I was contacted by a New York City veterinarian who often refers patients to me for second opinions. This time, his request was a bit different. One of his patients, a French poodle named Clea, was in France and had been diagnosed with melanoma of the tongue by a French veterinary oral surgeon. Clea’s owner wanted her treated with the DNA melanoma vaccine, a treatment not available in France. She and Clea would return to New York City, but she needed a local veterinary oncologist, so I was asked to help. Of course, I said yes.

Transatlantic medical information
Within minutes of saying yes, my email box filled with photos of Clea’s tumor, a biopsy report and photographs of the actual tumor cells under the microscope. Clea’s owner contacted me and arranged two appointments for Clea, one with me and one with our radiation oncologist, Dr. Rachel St-Vincent.

Treatment of melanoma of the oral cavity in a dog involves controlling the oral tumor using surgery or radiation therapy and using a vaccine to induce an immune response against the tumor in hopes of preventing spread of the tumor, especially to the lungs. The vaccine is not available in France, necessitating a trip home for the melanoma vaccine. Clea stayed with friends for eight weeks while she received four treatments of radiation and four doses of melanoma vaccine. When treatment was completed, she returned to France and her French veterinary team.

The French team
Even though Clea has both an American and a French team of veterinarians, we all speak the same language – veterinary medicine. The French oral surgeon, Dr. Phillipe Hennet, trained in the United States and holds a certification by the American Veterinary Dental College. When new tumors showed up in Clea’s lungs, he referred Clea to an American trained board certified small animal internal medicine specialist at his clinic, Dr. Suzy Valentin. She and I conferred via email to initiate the next step of treatment.

Back in the USA
Clea was back in New York City a few weeks ago and Dr. Valentin wanted another chest x-ray. Clea arrived at The AMC with a report by a French radiologist (in French) and a CD containing her lung CT scan from a month prior. The AMC has a radiologist, Dr. Alexandre Le Roux, who happens to be French. Looking for a translator, I took the written report and the images to him. To my surprise, the trail of veterinarians caring for Clea came full circle when Dr. Le Roux announced he knew Clea’s French radiologist!

Treatment success
For older pets like Clea, quality of life is possibly more important than quantity. I think Clea’s international healthcare team has achieved success based on this note from her owner: “So Clea is doing well. She is eating twice a day and loves the beef stew from the restaurant across the street. Dog food is definitely part of her past….”

How Many Ways Can the Thyroid Malfunction?

The thyroid gland sits in the neck of dogs and cats, just below the voice box, and controls metabolic functions. Most of the time, a routine physical examination cannot detect the organ if it is normal. Last week, my patient list ran the gamut of thyroid dysfunction. Here is a sampling:

A Tail of Two Thyroids

Some days, strange coincidences happen in the waiting room. Today it was two dogs, both with thyroid cancer. Although measuring 15 centimeters in length, Beckey’s thyroid tumor had been surgically removed. The biopsy showed her tumor trying to escape into the lymph vessels and she was waiting her turn for chemotherapy, administered to halt the spread. Her treatment involves intravenous administration of two different chemotherapy agents and Beckey so far has sailed through the treatment with flying colors.

As Beckey was leaving the waiting room, Henry entered. A CT scan showed his thyroid tumor had already spread to the lymph nodes in his neck, precluding surgical removal. He was in for a check-up following completion of four radiation therapy treatments. Careful measurement of his tumor with calipers showed no increase in tumor size. The radiation treatment arrested tumor growth but had given him a sore esophagus. I had warned the owners about this type of side effect before we started treatment and told them to expect it to start resolving about two weeks after he completed his treatment. Henry did not disappoint us. Through telephone triage, we had already rearranged his medications to make his throat less painful. Henry spends summer in the country but in the fall he will come back to The AMC for measurement of the tumor and a chest x-ray.

Old Patient, New Problem

Otra’s family was worried. This cute kitty had completed chemotherapy for intestinal lymphoma about a year ago, but suddenly her weight plummeted. I could see from the look on their faces they were sure the cancer was back. Auscultation of Otra’s heart discovered a very elevated heart rate, prompting a test of her thyroid levels. Overactive thyroid glands ramp up the cat’s metabolism and they lose weight despite eating well, have a high heart rate, and are very peppy. An abdominal ultrasound showed no evidence the lymphoma had recurred and blood tests showed the thyroid was overactive. I sent thyroid-suppressing medications home with the relieved family and planned to reassess the thyroid hormone levels in two weeks.

Porterhouse to Pork Chop

Every time I saw Mango to follow up on a skin tumor that had been completely removed via surgery, she had gained another pound. This 60-pound Portuguese Water Dog should have weighed 50 pounds. The owners took her swimming, fed her diet food from feeding toys, and still she gained two more pounds. During an evaluation for a urinary tract infection, we noted her thyroid hormone levels were borderline low. When we retested the levels three months later, we confirmed diagnosis of hypothyroidism. Low thyroid function, the opposite of Otra’s problem, can cause weight gain. Since she started treatment with thyroid supplementation, Mango has lost nearly 6 pounds and gone from a 20-ounce porterhouse to a 4-ounce pork chop over the past few months!

There you have it, thyroid malfunction runs the gamut of disease: overactive, underactive, and two different tumors, all in one tiny organ.

Ruptured Air Sac: A Unique Bird Disease

In 1984, The Animal Medical Center established one of the first Avian and Exotic Pet Services in a veterinary specialty hospital. At that time, the patients seen by the Avian and Exotic animal veterinarians reflected the most popular exotic pets such as ferrets, iguanas, and exotic cats. Over the years the popularity of various pets has waxed and waned, including the rise and fall of the hedgehog, sugar glider, prairie dog, and an occasional frog.

But the presence of birds in our waiting room has been a constant.

Raquel is a talkative blue and gold macaw that is at least 27 years old. She came to see Dr. Katherine Quesenberry for a dime-sized swelling in her axillary area (equivalent to our armpit) between the base of her wing and flank. Dr. Quesenberry suspected a ruptured air sac and scheduled a CT scan to investigate further.

Evolution made birds lightweight for flying. To lighten their bones, some bones contain air (pneumatic bones) as part of their respiratory system. Like reptiles and mammals, birds also have lungs, but bird lungs function differently than ours. With each breath, our lungs fill and empty with air due to movement of the diaphragm. Birds lack a diaphragm, and air moves through the lungs and into and out of the air sacs in two cycles as their sternum expands and contracts with each breath. While air is in the lungs, exchange of oxygen and carbon dioxide occurs. The air sacs help keep birds “light as a feather” and buoyant for flight.

Even though The AMC’s 64-slice CT scan is lightning fast, general anesthesia is required for the procedure. The bird’s unusual respiratory system makes anesthesia a greater challenge than in dog and cat patients. While birds are under anesthesia, we assist their breathing to prevent a build up of anesthetic gases in their air sacs. The advantage that birds have over mammals is that because their respiratory cycle is so fast, they wake up from anesthesia rapidly once the anesthetic gas is discontinued.

On the right you see a reconstructed image of Raquel from her CT scan. Although you can’t see it, her head is at the top, legs at the bottom. The image clearly shows the abnormal air sac exactly as the examination described it, under the right wing. The image is reversed and the right side is shown on the left.

The cause of ruptured air sacs is unknown; even so, they can be successfully treated. A small stent was sutured into Raquel’s ruptured air sac to remove the accumulated air. A follow-up visit showed resolution of the swelling. Raquel is now doing well and hopefully will stay in good health for at least another 27 years!

Photo: Photo of Raquel courtesy of Lynne Freeman-Gassem

_______________________________________________________

This may also be found in the Tales from the Pet Clinic blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.

Vacuum-Assisted Positioning Device: Another Cool AMC Tool

The Animal Medical Center has all kinds of cool equipment to help make treating diseases in dogs and cats faster, safer and more successful. Today’s blog is about one of those devices, the vacuum assisted positioning device used by our radiation oncologist.

The video below shows a feline patient under anesthesia and being positioned by Dr. John Farrelly, AMC’s radiation oncologist, in the vacuum-assisted positioning device.

When you watch the video you will:

Hear
The clicking on/off of the vacuum pump and the beeping monitors for the devices monitoring heart rate and respirations.

See
A cat under general anesthesia with a visible tumor, laying on his back on the vacuum-assisted positioning device pillow.

Not See
The anesthesia machine attached to the cat’s breathing tube and a nurse monitoring anesthesia. There is also a console outside the CT scan room where the machine controls are housed.

What is a vacuum-assisted positioning device?
The large white “pillow” the cat is laying on is filled with little pellets, similar to a bean bag. The pillow attaches to a vacuum device that extracts the air from the pillow causing the pillow to mold around the anesthetized cat. The device retains the shape of the cat after the vacuum lines are locked in place.

Why do we use vacuum-assisted positioning devices?
This device ensures exact placement of the patient for each radiation therapy treatment and allows very precise delivery of the radiation treatment.

All of us at The AMC hope your pet never needs radiation therapy for a tumor, but if he does, the vacuum assisted positioning device will help us (and other vets) deliver the best possible treatment available.

________________________________________________________

This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.

Pets and Vets Need Techs: National Veterinary Technician Week

October 9-15, 2011 is National Veterinary Technician Week.

Because of his firsthand experience with the skilled and devoted licensed veterinary technicians at the AMC, Jack Black the cat volunteered to give a report on the role of veterinary technicians as he sees it looking out from cage #3 in AMC’s ICU.

Jack Black: In His Own Words, Err…Meows

I have inflammatory bowel disease and diabetes. When I come to the AMC to have my weight monitored, my blood glucose measured and my fructosamine checked, technicians Sandy and Maria always draw my blood and weigh me while the doctors are talking to my family. Since I am on a special diet they don’t give me any treats, but I see them giving everyone else treats after their blood is drawn, which is a real bummer. They also give me my pills so my family gets a day off.

Recently, an AMC veterinarian diagnosed me with colon cancer using an endoscope. I saw the endoscope cabinet, and it is full of different scopes used to look at internal organs, such as the lungs and intestines. The Internal Medicine Service technician, Lori, is responsible for the care and maintenance of all the endoscopes, so they are always ready for emergency removal of something stuck inside a dog or cat or to diagnose inflammatory bowel disease or cancer. The technicians were very kind and caring towards me when I got my diagnosis, so I wasn’t worried at all!

My surgeon ordered a chest x-ray to evaluate my lungs and a CT scan of my abdomen to help with pre-surgery planning. In the diagnostic imaging suite, technicians Rafael and Corrado operate the AMC’s x-ray machine, CT scanner and MRI machine. The AMC’s CT scanner is so fast I didn’t have to stay overnight again, which made me and my family very happy.

Last week when I came back to The AMC to have the tumor removed from my colon, I met an entire new group of technicians working in anesthesia and the recovery room.

Catherine placed an intravenous catheter and wrapped it with some tape that had paw prints on it. Next, the technicians administered an intravenous infusion of an anesthetic agent and, once I was asleep, placed a breathing tube in my windpipe. The tube delivered the anesthetic gas during the surgery. They also monitored my blood pressure, blood oxygen level and blood sugar during surgery. When I woke up after surgery, the technicians gave me pain medication and kept me toasty warm, using the Bair Hugger® in the recovery room. I wouldn’t mind taking that Bair Hugger home with me.

After I recovered from anesthesia, I was moved to ICU. ICU is the AMC’s busiest ward, and I like it here because I have three technicians assigned to meet my every need — Lilia, Stephanie and Amy. I have three because they take care of me 24 hours a day, and even though I am their favorite patient, they need to go home and sleep so they are fresh and rested for their shift. When my family visits, the techs tell them all about what has happened to me that day, and my family feels better knowing how much they care about me.

Thanks, Jack!

Thanks to Jack Black the cat for highlighting the importance of veterinary technicians in animal healthcare. I hope his report helps our blog readers to understand pets need techs and so do veterinarians – not just during National Veterinary Technician Week, but every single day!

Photos: Courtesy of the AMC Veterinary Technicians

________________________________________________________

This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.

The War Horse Kitten

Many New Yorkers believe the best play currently on Broadway is War Horse, adapted from the children’s story of the same name.

The War Horse is named Joey and inspired the name of the patient whose miraculous story I tell below.

At 10 weeks of age and weighing only one scrawny pound, Joey was admitted to the AMC. She was all personality. When her cage door was opened, she would launch herself onto your shoulder and purr in your ear. But even at her tender age, she had already been through a medical war of sorts, hence her name.

Joey’s medical war started just before she was ready to go to her new family, when everything she was eating started coming back up through her nose and mouth. Even if food and water were given with an eyedropper, 15 drops were too much.

Because of her age, her AMC team considered a rare congenital problem where an aberrant blood vessel tightens around the esophagus and blocks the passage of food. To diagnose this rare condition, Joey was anesthetized for CT scanning. Three nurses hovered around this tiny kitten to ensure proper anesthetic monitoring. Fortunately the CT scan showed Joey did not have this condition and her internal medicine team was relieved since treatment for this condition requires immediate thoracic surgery. But, the CT scan showed a narrowing of the esophagus due to the presence of some abnormal looking tissue.

The second part of Joey’s medical battle involved using the bronchoscope to view the inside of her esophagus. This is the same piece of equipment used to remove the pen cap from Barclay’s trachea.

Normally we would not use the bronchoscope to look at an esophagus, but Joey was too tiny for the usual scope. Dr. Douglas Palma, Small Animal Internal Medicine specialist at the AMC, found a polyp of the esophagus was the cause of the narrowing. The esophagus had shrunken down to barely a pinhole and also had an out-pouching called a diverticulum.

The photo at right shows a thin wire passed through the esophagus on the right and the diverticulum on the left.

The next part of Joey’s war involved placing a feeding tube past the narrowing and into the stomach to allow the esophagus to rest and to allow Joey to get food and water.

The AMC veterinarians thought they had won the battle, but a couple of weeks after the feeding tube was removed, food started coming up through Joey’s nose again. This time the diagnosis was an abscess in the area of the previous diverticulum. Very strong antibiotics were required, and after an initial course in the hospital, Joey’s family continued the antibiotic injections at home.

Today, thanks to the dedication of her family and the skill of her AMC Internal Medicine team, Joey is no longer the scrawny kitten seen in these photographs. She still has not quite completed treatment and needs her esophagus stretched to allow food to pass more easily into the stomach, but she is well on her way to good health. Throughout this entire ordeal, Joey has been sweet, loving and as her family says, “a piece of work.” The AMC is happy to have contributed to this work in progress.

________________________________________________________

This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.

Day at the Museum: The Animal Medical Center Sequel

The Animal Medical Center has a computer system to manage our diagnostic imaging, including x-rays, ultrasound, CT scans and MRIs. The Picture Archiving and Communications System (PACS) lists all the images for any given day. If you looked at the list for June 17, you would see my patient Dakota, who got a chest x-ray, Chippie, the dog who had a full series of dental x-rays, and BooBoo who had a brain MRI — a typical list for a Friday.

But reading down the list you get to Croc 1, Bird 2, Snake 3 and Ibis 4. These images come from the oldest patients ever seen at The AMC. No, not a 25 year old dog or a 30 year old cat. These 32 patients are 2,500 year old animal mummies.

Like many AMC patients, these animals came to The AMC across the Brooklyn Bridge into Manhattan. Unlike any other AMC patients, these patients belong to the Brooklyn Museum’s Egyptian collection.

Like all patients who come to The AMC, they came for our diagnostic expertise, utilizing our state of the art equipment. In this case, the animal mummies came to The AMC for CT scanning in our 64-slice CT scanner.

The AMC’s 64-slice CT scanner rapidly produces high quality images. So fast, all 32 were scanned in one day as outpatients! Rapid is better for our usual patients, since the faster the scan, the shorter the anesthesia time. For the animal mummies, the high quality images are critical in helping AMC’s board certified radiologist, Dr. Anthony Fischetti, collaborate with the curators from the Brooklyn Museum to decipher the mummy’s contents. The 64-slice CT scanner can recreate three dimensional and multiplanar images of the patient. In our usual patients, we use these features to better diagnose and treat illnesses. Our colleagues at the Brooklyn Museum plan to use the reconstructed CT images to study the mummies’ contents without disrupting the intricate linen wrapping.

If our CT scanner is so fast and can scan thirty two mummies in one day, you might wonder why your AMC veterinarian wanted your pet here all day when it had a CT scan. A CT scan in one of our usual patients requires administration of a short-acting anesthetic. Obviously, an animal mummy does not require anesthesia, the associated monitoring of the heart, respiration and blood pressure and does not have to recover from anesthesia. All these differences shorten the procedure time.

Most of our usual patients have two CT scans back to back. The first scan is before and the second is after administration of a contrast agent. The contrast agent highlights abnormalities the veterinarians are hunting for, such as inflammation and tumors. Administration of contrast was not possible or necessary in the animal mummies.

This animal mummy project between The Animal Medical Center and the Brooklyn Museum will culminate in an exhibition in 2013, so mark your calendars now!

________________________________________________________

This may also be found in the “Tales from the Pet Clinic” blog on WebMD.com.

For over a century, The Animal Medical Center has been a national leader in animal health care, known for its expertise, innovation and success in providing routine, specialty and emergency medical care for companion animals. Thanks in part to the enduring generosity of donors, The AMC is also known for its outstanding teaching, research and compassionate community funds. Please help us to continue these efforts. Send your contribution to: The Animal Medical Center, 510 East 62nd Street, New York, NY 10065. For more information, visit www.amcny.org. To make an appointment, please call 212.838.7053.